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Acute, Recurrent, and Chronic Laryngopharyngeal Reflux: The IFOS Classification.

Jérôme R Lechien, Quentin Lisan, Claudia A Eckley, Abdul-Latif Hamdan, Young-Gyu Eun, Stéphane Hans, Sven Saussez, Lee M Akst, Thomas L Carroll

Journal: The Laryngoscope 2023;133(5):1073-1080

PMID: 36250977

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Abstract

OBJECTIVE

To investigate the clinical patterns and disease evolution of laryngopharyngeal reflux (LPR) patients.

METHODS

Patients with LPR diagnosed by hypopharyngeal-esophageal impedance-pH monitoring were prospectively followed in three medical centers. Symptoms and findings were assessed with reflux symptom score (RSS) and reflux sign assessment (RSA). Patients were treated with 3-to 9-month diet and combination of proton pump inhibitors, alginate or magaldrate. Patients were followed for 3 years to determine the clinical evolution of symptoms over time. LPR that did not recur was defined as acute. Recurrent LPR consisted of reflux with one or several recurrences yearly despite successful treatment. Chronic LPR was reflux with a chronic course of symptoms. Predictive indicators of clinical evolution were investigated.

RESULTS

One hundred forty patients and 82 healthy individuals completed the evaluations. Among patients, 41 (29.3%), 57 (40.7%), and 42 (30.0%) had acute, recurrent, or chronic LPR respectively. Baseline quality of life-RSS (QoL-RSS) and RSS total scores were significantly higher in chronic LPR patients. The post-treatment decrease of QoL-RSS and RSS of acute LPR patients were significantly faster as compared to recurrent and chronic patients. QoL-RSS >5 reported adequate sensitivity (94.2) and specificity (75.3). QoL-RSS thresholds defined acute (QoL-RSS = 6-25), recurrent (QoL-RSS = 26-38), and chronic (QoL-RSS > 38) LPR.

CONCLUSION

Baseline QoL-RSS may predict the clinical course of LPR patients: acute, recurrent, or chronic. A novel classification system that groups patients according to the longevity, severity, and therapeutic response of symptoms was proposed: the International Federation of Otorhinolaryngological Societies Classification of LPR.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:1073-1080, 2023.

© 2022 The American Laryngological, Rhinological and Otological Society, Inc.

Address: Department of Otolaryngology, Elsan Hospital, Paris, France.; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Brussels, Belgium.; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.; Divisão de Otorrinolaringologia, Fleury Medicina e Saúde Laboratórios de Diagnóstico, São Paulo, Brazil.; Department of Otorhinolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.; Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea.; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre (CHU de Bruxelles), Brussels, Belgium.; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.; Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.
DOI: 10.1002/lary.30322

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MeSH Terms: Humans, Laryngopharyngeal Reflux, Quality of Life, Esophageal pH Monitoring, Proton Pump Inhibitors
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